The Impact of Histological Clot Composition in Embolic Stroke
The Impact of Histological Clot Composition in Embolic Stroke
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DOI：
10.1007/s00062-014-0347-x
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发表时间：
2016-06-01
影响因子：
2.8
通讯作者：
Poppert, H.
中科院分区：
文献类型：
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作者：
Boeckh-Behrens, T.;Schubert, M. I.;Poppert, H.
血栓成分已被认为对因栓塞性卒中而接受机械血栓切除术治疗的患者的结局具有决定性影响。支架取栓器的最新发展允许收集新鲜血栓材料，并因此进行组织病理学分析。在此背景下，本前瞻性研究的目的是评估血栓成分对机械再通、临床结局和卒中病因的影响。对34例因远端颈内动脉/颈动脉-T、大脑前动脉或大脑中动脉闭塞而患急性缺血性卒中的患者进行了机械再通，并获得了血栓物质。将组织学血栓成分与影像学、临床和神经介入数据进行比较，主要发现是血栓中较高百分比的白色血细胞（WBC）与（i）心源性栓塞病因相关，（ii）机械再通时间延长，和（iii）再通不良（脑梗死溶栓评分）和临床结局（国立卫生研究院卒中量表）我们的研究结果表明，具有高WBC分数的血栓与心源性血栓相关，急性缺血性前循环卒中的再通和临床结局。白细胞介导的免疫和凝血过程可能在血栓形成和卒中发病机制中起关键作用，有待进一步研究。
Thrombus composition has been suggested to have a decisive impact on the outcome of patients treated by mechanical thrombectomy because of embolic stroke. The recent development of stent retrievers allows collection and, hence, histopathological analysis of fresh thrombus material. Against this background, the aim of this prospective study was to assess the impact of thrombus composition on mechanical recanalization, clinical outcome and stroke etiology.Thirty-four patients suffering from acute ischemic stroke due to occlusion of the distal internal carotid artery/carotid-T, anterior cerebral artery, or middle cerebral arteries were mechanically recanalized, and thrombus material was obtained. Histological thrombus composition was compared with imaging, clinical, and neurointerventional data.The main findings were that a higher percentage of white blood cells (WBCs) in the thrombus was associated with (i) cardioembolic etiology, (ii) extended mechanical recanalization time, and (iii) less favorable recanalization (Thrombolysis in Cerebral Infarction score) and clinical outcome (National Institute of Health Stroke Scale).Our results suggest that thrombi with a high WBC fraction are related to more organized thrombi of cardioembolic origin associated with less favorable recanalization and clinical outcome in acute ischemic anterior circulation stroke. WBC-mediated immunological and coagulatory processes may play a key role in thrombus formation and pathogenesis of stroke warranting further investigation.